Provider Demographics
NPI:1396098604
Name:MEDLEY, JOSH (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:MEDLEY
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5414
Mailing Address - Country:US
Mailing Address - Phone:720-204-0909
Mailing Address - Fax:
Practice Address - Street 1:420 S 39TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5414
Practice Address - Country:US
Practice Address - Phone:720-204-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 0012194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional